Postpartum Resolution of Glomerular Changes in Edema-Proteinuria-Hypertension Gestosis

Oe, P. L.; Ooms, E. C. M.; Uttendorfsky, O.T.; Stolte, L.A.M.; Delden, L. van; Graaff, P.

doi:10.1159/000172786

Cited by 6 publications

(4 citation statements)

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“…This persistent improvement of K f in preeclampsia during the first postpartum month parallels that of albuminuria and blood pressure ( Table 2). That improving K f reflects recovery of the injured glomerular endothelial cell and parallels pathological observations that the severity of endotheliosis correlates inversely with the postpartum day on which the biopsy was performed (21,24,25).…”

Section: Discussionsupporting

confidence: 70%

Course of preeclamptic glomerular injury after delivery

Hladunewich

Myers²,

Derby³

et al. 2008

American Journal of Physiology-Renal Physiology

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Hladunewich MA, Myers BD, Derby GC, Blouch KL, Druzin ML, Deen WM, Naimark DM, Lafayette RA. Course of preeclamptic glomerular injury after delivery. Am J Physiol Renal Physiol 294: F614-F620, 2008. First published January 16, 2008 doi:10.1152/ajprenal.00470.2007.-We evaluated the early postpartum recovery of glomerular function over 4 wk in 57 women with preeclampsia. We used physiological techniques to measure glomerular filtration rate (GFR), renal plasma flow, and oncotic pressure ( A) and computed a value for the two-kidney ultrafiltration coefficient (Kf). Compared with healthy, postpartum controls, GFR was depressed by 40% on postpartum day 1, but by only 19% and 8% in the second and fourth postpartum weeks, respectively. Hypofiltration was attributable solely to depression, at corresponding postpartum times, of Kf by 55%, 30%, and 18%, respectively. Improvement in glomerular filtration capacity was accompanied by recovery of hypertension to near-normal levels and significant improvement in albuminuria. We conclude that the functional manifestations of the glomerular endothelial injury of preeclampsia largely resolve within the first postpartum month. glomerular filtration rate; ultrafiltration coefficient; postpartum recovery AFFECTING 5-7% of pregnancies, preeclampsia remains a leading cause of maternal and fetal morbidity and mortality. Because the primary target of injury in preeclampsia is the glomerular endothelial cell, affected patients invariably present with depression of the glomerular filtration rate (GFR), proteinuria, and hypertension. We previously (13) evaluated glomerular morphology immediately after delivery. We demonstrated severe endothelial cell swelling with diminished size and density of the endothelial fenestrae, along with mesangial cell interposition and subendothelial fibrinoid deposits. These findings were computed to lower glomerular filtration capacity sufficiently to account for the observed depression of GFR by 40% (13).Despite the profound alterations in glomerular morphology, clinical recovery is usually rapid after delivery of the placenta. However, few detailed physiological evaluations of preeclampsia have been undertaken in the postpartum period. The characteristic glomerular pathological lesion has been reported to improve within days after delivery (21). Although complete recovery can occasionally require in excess of 6 mo, the majority of cases demonstrate complete resolution of the renal pathology within 3 mo (25). With the exception of those women with persistent postpartum hypertension, GFR and proteinuria also normalize over several months (18,(32)(33)(34).In the present study, we have employed precise physiological techniques to evaluate the postpartum course of the GFR and its determinants in women with preeclampsia. We combined our physiological findings with mathematical modeling to estimate glomerular ultrafiltration capacity. We observed a profound initial injury, which improved significantly after 4 wk. METHODSPatient population. This paper represents a...

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Section: Discussionsupporting

confidence: 70%

Course of preeclamptic glomerular injury after delivery

Hladunewich

Myers²,

Derby³

et al. 2008

American Journal of Physiology-Renal Physiology

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“…Glomerular lesions of preeclampsia involve MPGN-like changes, including mesangial hypercellularity, duplication of the glomerular capillary wall, and swelling of endothelial cells. Although these changes typically recover within a few months, some cases have been reported in which such changes persisted as long as 2 years [11]. These histological findings are consistent with those found in our case.…”

Section: Discussionsupporting

confidence: 93%

A case of idiopathic membranoproliferative glomerulonephritis with a transient glomerular deposition of nephritis-associated plasmin receptor antigen

et al. 2011

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The differential diagnosis of acute poststreptococcal glomerulonephritis (APSGN) and idiopathic membranoproliferative glomerulonephritis (MPGN) is sometimes difficult, as they share several key features in their laboratory and histological findings, especially during the acute phase of the diseases. We herein report an idiopathic case of MPGN in which the glomerular deposition of nephritis-associated plasmin receptor (NAPlr), a recently identified nephritic antigen for APSGN, was demonstrated. A 24-year-old postpartum woman developed nephrotic syndrome and hypocomplementemia. Although she showed no apparent findings of a prior infection, her serum titer of antistreptolysin O antibody was elevated. Renal biopsies were performed twice at intervals of 6 months, both of which showed findings fully consistent with those of MPGN. Of note, fluorescent immunostaining for NAPlr was positive in the glomeruli of the first biopsy but not in the second. Despite the use of a corticosteroid, hypocomplementemia persisted for more than 1 year. It was therefore suggested that a streptococcal infection may have influenced the development of glomerular injury in this idiopathic case of MPGN.

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“…In our search for articles related to kidney biopsy and pregnancy, 51 full‐text articles were retrieved from 949 references (297 from Medline, with the limit ‘human’, 632 from Embase, 17 from CHINAL and three from the Cochrane Library). After the exclusion of four papers as duplicates, 39 fulfilled the selection criteria (Figure ) . Of these, five studies dealt with kidney biopsy in pregnancy only, six included women who underwent a kidney biopsy in pregnancy and after delivery, and 28 included biopsies performed only after delivery (Table ).…”

Section: Resultsmentioning

confidence: 99%

Kidney biopsy in pregnancy: evidence for counselling? A systematic narrative review

Piccoli¹,

Daidola²,

Attini³

et al. 2013

BJOG

173

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Background Kidney diseases, which have a prevalence of 3% in women of childbearing age, are increasingly encountered in pregnancy. Glomerulonephritis may develop or flare up in pregnancy, and a differential diagnosis with pre-eclampsia may be impossible on clinical grounds. Use of kidney biopsy is controversial, but a systematic review has not been carried out to date.Objectives To review the literature on kidney biopsy in pregnancy, with a focus on indications, risks and timing.Search strategy Medline, Embase, CHINAL and the Cochrane Library were searched in September 2012, with 'pregnancy' and 'kidney biopsy' used as MESH and free terms, for the period 1980-2012. Results were filtered for 'human' if this option was available.Selection criteria Biopsies during pregnancy and within 2 months after delivery. Case reports (fewer than five cases) and kidney grafts were excluded. Paper selection was performed in duplicate.Data collection and analysis Data were extracted in duplicate. The high heterogeneity in study design necessitated that the review be narrative, except for data on adverse events, which were analysed with regard to the timing of kidney biopsy.Main results Of 949 references, 39 were selected, providing data on 243 biopsies in pregnancy and 1236 after delivery (timing was unclear in 106 women). The main aims of the studies were to define morphology in pre-eclampsia (23 studies), to carry out a riskbenefit analysis of kidney biopsy (11 studies), and to investigate pregnancy-related acute kidney injury (five studies). Four cases of major bleeding complications occurred at 23-26 weeks of gestation. Relevant complications were observed in 7% of women during pregnancy and 1% after delivery (P = 0.001). Kidney biopsy performed for the diagnosis of glomerulonephritis or pre-eclampsia led to therapeutic changes in 66% of cases.Authors' conclusions The evidence on kidney biopsy in pregnancy is heterogeneous, but a significantly higher risk of complications (relative to postpartum biopsy) was found, with a possible peak at around 25 gestational weeks.

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Postpartum Resolution of Glomerular Changes in Edema-Proteinuria-Hypertension Gestosis

Cited by 6 publications

References 0 publications

Course of preeclamptic glomerular injury after delivery

Course of preeclamptic glomerular injury after delivery

A case of idiopathic membranoproliferative glomerulonephritis with a transient glomerular deposition of nephritis-associated plasmin receptor antigen

Kidney biopsy in pregnancy: evidence for counselling? A systematic narrative review

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